Basic Information
| Provider Information | |||||||||
| NPI: | 1134327141 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREGORY D. HAYNES, MD P.C. | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 401 MULBERRY ST SW | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | LENOIR | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286455463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285721770 | ||||||||
| FaxNumber: | 8285721763 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 MULBERRY ST SW | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | LENOIR | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286455463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8285721770 | ||||||||
| FaxNumber: | 8285721763 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2007 | ||||||||
| LastUpdateDate: | 08/23/2010 | ||||||||
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| AuthorizedOfficialLastName: | HAYNES | ||||||||
| AuthorizedOfficialFirstName: | GREGORY | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8285721770 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 2008-00455 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 2628362 | 05 | MI | MEDICAID | 5909243 | 05 | NC | MEDICAID |